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The Hermitage Dark Retreat Questionnaire
Proceed your Dark Retreat Process by answering the following questions. Your answers will be kept confidential.
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* Indicates required question
Email
*
Your email
Full Name
*
Your answer
Gender
*
Male
Female
Other:
Birthday
*
MM
/
DD
/
YYYY
Time of Birth
*
Time
:
AM
PM
Place of Birth & Country
*
Your answer
What's App Phone Nr. (+ Country Code)
*
Your answer
Emergency Contact (name, relationship & contact nr.)
*
Your answer
What is your past experience with retreats (group, solitary, dark)? And where?
*
Your answer
Have you been at the Hermitage before?
*
No
for a Dark Retreat
for a Solitary Retreat
for a Group Retreat
Required
How did you hear about the Dark Retreat?
*
Your answer
What is your Intention going into the Dark?
*
Your answer
Do you have any food allergies?
*
Your answer
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